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Cardiac > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What causes S1 sound?

A

Closure of mitral and tricuspid valves

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2
Q

What causes S2 sound?

A

Closure of aortic and pulmonic valves

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3
Q

What might an S3 heart sound suggest?

A

Congestive heart failure

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4
Q

What might an S4 heart sound suggest?

A

Poor ventricular compliance

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5
Q

Location for auscultating aortic valve sounds?

A

Right sternal border at 2nd intercostal space

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6
Q

Location for auscultating pulmonic valve sounds

A

Left sternal border at 2nd intercostal space

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7
Q

Location for auscultating mitral valve sounds

A

Left midclavicular line at 5th intercostal space

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8
Q

Location for auscultating tricuspid valve sounds

A

Left sternal border at 4th intercostal space

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9
Q

Heart sound that marks onset of systole

A

S1

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10
Q

Heart sound that marks the onset of diastole

A

S2

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11
Q

Heart sound that marks beginning of isovolumic contraction

A

S1

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12
Q

Heart sound that marks beginning of isovolumic relaxation

A

S2

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13
Q

Heart sound is louder with vigorously contracting ventricle

A

S1

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14
Q

Heart sound is softer with poorly contracting ventricle

A

S1

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15
Q

Heart sound is louder with hypertension

A

S2

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16
Q

Heart sound is softer with hypotension

A

S2

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17
Q

When is S3 heard?

A

During middle 1/3 of diastole- after S2

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18
Q

What causes S4 heart sound?

A

Atrial systole

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19
Q

When is S4 heard?

A

Before S1

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20
Q

What part of the stethoscope is best for listening to high pitched sounds (S1, S2, regurgitation)?

A

Diaphragm

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21
Q

What part of the stethoscope is best for listening to low pitched sounds (S3, S4, mitral stenosis)?

A

Bell

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22
Q

What type of valvular lesion results in concentric hypertrophy?

A

Stenosis

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23
Q

Valvular, fixed obstruction to forward flow

A

Stenosis

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24
Q

Valvular lesion- turbulent blood flow, higher velocity of travel

A

Stenosis

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25
Q

Cardiac compensation in which sarcomeres are added in a parallel fashion and the wall chamber becomes thicker > reduces chamber radius

A

Concentric hypertrophy

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26
Q

Incompetent valve

A

Regurgitation

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27
Q

Valvular lesion- some blood flows forward and some blood flows backward

A

Regurgitation

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28
Q

Valvular lesion- volume overload

A

Regurgitation

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29
Q

Heart compensates by adding sarcomere in series > chamber radius increases

A

Eccentric hypertrophy

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30
Q

Normal aortic valve area

A

2.5- 3.5 cm2

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31
Q

Aortic valve area in severe aortic stenosis

A

≤0.8 cm2

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32
Q

Etiologies of aortic stenosis

A

Bicuspid aortic valve
Rheumatic fever
Infective endocarditis

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33
Q

Compensatory mechanisms of aortic stenosis

A

Increased thickness of the left ventricular wall
Decreased compliance
Smaller chamber radius

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34
Q

Presentation of aortic stenosis

A

Syncope
Angina
Dyspnea

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35
Q

Anesthetic goals for aortic stenosis

A

HR: Avoid tachycardia
Rhythm: NSR (maintain atrial kick)
Preload: Increase
Afterload: Maintain or increase
Contractility: Maintain
Pulmonary vascular resistance: Normal

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36
Q

Anesthetic considerations for aortic stenosis

A

Avoid spinal anesthesia in patients with severe aortic stenosis

Chest compressions often ineffective

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37
Q

Arterial waveform of aortic stenosis

A

May show:
Pulsus tardus
Pulsus parvus

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38
Q

Transvalvular pressure gradient in aortic stenosis

A

> 40 mmHg

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39
Q

Wall tension in aortic stenosis (increased or decreased)

A

Increased

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40
Q

EDV and ESV in aortic stenosis (increased or decreased)

A

Increased

41
Q

What valvular lesion does the pressure volume loop represent?

A

Aortic stenosis

42
Q

What is pulsus tardus?

A

Slower systolic upstroke on arterial waveform

43
Q

What is pulsus parvus?

A

Narrow pulse pressure with small amplitude waveform on arterial line tracing

44
Q

Effects of aortic insufficiency on the left ventricle

A

Volume overload
Eventual eccentric hypertrophy

45
Q

Etiologies of aortic regurgitation

A

Incompetent valve
Dilation of the aortic root/ supporting structures

46
Q

What conditions should be avoided in aortic regurgitation?

A

Bradycardia
Increased SVR
Large valve orifice

47
Q

How is cardiopulmonary bypass approach different in patients with aortic regurgitation?

A

Cardioplegia must be injected retrograde (through coronary sinus) or directly into each coronary ostia

48
Q

What are causes of acute aortic insufficiency?

A

Endocarditis (most common)

Aortic root dissection from aneurysm or trauma

49
Q

What is the pathophysiology of acute aortic insufficiency?

A

LV becomes acutely dilated > increased wall tension > LV failure > rapid cardiovascular instability

50
Q

What conditions are associated with aortic insufficiency?

A

Valvular calcification
Marfan syndrome
Ehler-Danlos syndrome
Ankylosing spondylitis

51
Q

Heart rate goal for aortic insufficiency

A

Increased

52
Q

Preload goal for aortic insufficiency

A

Maintain/ increase

53
Q

Contractility goal for aortic insufficiency

A

Maintain

54
Q

SVR goal for aortic insufficiency

A

Decrease

55
Q

Pulmonary vascular resistance goal for aortic insufficiency

A

Maintain

56
Q

What valvular lesion is associated with a sharp upstroke, low diastolic pressure, and wide pulse pressure on the arterial waveform?

A

Aortic insufficiency

57
Q

What valvular lesion may have this arterial waveform tracing?

A

Aortic insufficiency

58
Q

What valvular lesion may have this arterial waveform tracing?

A

Aortic stenosis

59
Q

What valvular lesion does the pressure volume loop represent?

A

Chronic aortic regurgitation

60
Q

What valvular lesion does the pressure volume loop represent?

A

Mitral stenosis

61
Q

Normal area of the mitral valve orifice

A

4-6 cm2

62
Q

Area of mitral valve orifice in severe mitral stenosis

A

<1 cm2

63
Q

Quantitative indications of severe mitral stenosis

A

Transvalvular pressure gradient >10 mmHg

Pulmonary artery systolic pressure >50 mmHg

64
Q

Most common causes of mitral stenosis

A

Rheumatic fever (developing nations)

Endocarditis (United States)

Calcification of the mitral annulus secondary to atherosclerosis (United States)

65
Q

Etiologies of mitral stenosis

A

Rheumatic fever

Endocarditis

Calcification of the mitral annulus secondary to atherosclerosis

Rheumatic arthritis

Systemic lupus erythematosus

Congenital defect

Left atrial myxoma

Carcinoid syndrome

Iatrogenic following mitral valve repair

66
Q

What valvular lesion does the pressure volume loop represent?

A

Mitral stenosis

67
Q

The image depicts the pathophysiology of which valvular lesion

A

Mitral stenosis

68
Q

Heart rate goal for mitral stenosis

A

Slower end of normal

69
Q

Preload goal for mitral stenosis

A

Maintain

70
Q

Contractility goal for mitral stenosis

A

Maintain

71
Q

SVR goal for mitral stenosis

A

Maintain

72
Q

Pulmonary vascular resistance goal for mitral stenosis

A

Avoid increase

73
Q

Regional anesthesia considerations for mitral stenosis

A

Pts are prone to atrial fibrillation and may be anticoagulated. Avoid neuraxial anesthesia in pts with INR >1.5

74
Q

What valvular lesion does the pressure volume loop represent?

A

Chronic mitral regurgitation

75
Q

The image depicts the pathophysiology of which valvular lesion

A

Mitral regurgitation

76
Q

Etiologies of mitral insufficiency

A

Rheumatic fever
Ishcemic heart disease
Papillary muscle dysfunction
Ruptured chordae tendineae
Endocarditis
Mitral valve prolapse
Left ventricular hypertrophy
Systemic lupus erythematosus
Rheumatoid arthritis
Carcinoid syndrome

77
Q

Mitral insufficiency results in:

A

Volume overload
Eccentric hypertrophy (left atrium)

78
Q

Conditions to avoid in mitral insufficiency

A

Slow heart rate

Increased pressure gradient between the LV and LA

Increased SVR

Increased size of valve orifice

79
Q

Heart rate goal in mitral insufficiency

A

Increased (NSR)

80
Q

Preload goal in mitral insufficiency

A

Maintain or increase

81
Q

Contractility goal in mitral insufficiency

A

Maintain

82
Q

SVR goal in mitral insufficiency

A

Decrease

83
Q

Pulmonary vascular resistance goal in mitral insufficiency

A

Avoid increase

84
Q

Systolic murmurs

A

Aortic stenosis
Mitral regurgitation

85
Q

Diastolic murmurs

A

Aortic regurgitation
Mitral stenosis

86
Q

Characteristics of aortic stenosis assessment

A

Auscultated at right sternal border through aorta and carotid arteries

May be confused with bruit

May be palpated as a thrill

May decrease with severity

87
Q

Characteristics of aortic regurgitation assessment

A

High pitch blowing murmur

Auscultated at right sternal border

88
Q

Characteristics of mitral stenosis assessment

A

Opening snap followed by low intensity rumbling murmur

Auscultated at the apex and left axilla

89
Q

Characteristics of mitral regurgitation assessment

A

Holosystolic murmur- loud swishing sound

Auscultated at apex and left axilla

90
Q

The three surgical approaches for transcatheter aortic valve replacement

A

Transfemoral
Transaortic
Transapical (antegrade)

91
Q

Benefits of transcatheter aortic valve replacement

A

Sternotomy not required
Cardiopulmonary bypass not required

92
Q

Most common valves used for transcatheter aortic valve replacement

A

Edwards SAPIAN
Medtronic CoreValve

93
Q

Type of artificial valve that requires balloon valvulosplasty

A

SAPIAN

94
Q

Type of artificial valve that requires rapid ventricular pacing

A

SAPIAN

95
Q

Considerations for rapid ventricular pacing

A

Profound hypotension during pacing

Ensure MAP >75 mmHg before pacing

Have radiotranslucent pads on pt prior to pacing

Keep pt apneic during pacing

96
Q

Self-expanding artificial valve

A

CoreValve

97
Q

Improper artificial valve deployment symptom

A

Acute aortic insufficiency

98
Q

Surgical treatment for improper artificial valve deployment

A

SAPIAN- place another SAPIAN valve through malpositioned valve (valve-in-valve procedure)

CoreValve- retrieve and redeploy

99
Q

Complications fo transcatheter aortic valve replacement

A

Vascular injury (hemorrhage)

Coronary occlusion

Annular rupture (cardiac tamponade> cardiovascular collapse)

Stroke

Perivalvular leak

Pericardial tamponade

AV block

LBBB

3rd degree block if pt has preexisting RBBB

Cardiac (4 decks)

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